Provider Demographics
NPI:1417240656
Name:JEFFREY P GAITZ MDPA
Entity Type:Organization
Organization Name:JEFFREY P GAITZ MDPA
Other - Org Name:JEFFREY P. GAITZ M.D. PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-861-6555
Mailing Address - Street 1:1740 W 27TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1433
Mailing Address - Country:US
Mailing Address - Phone:713-861-6555
Mailing Address - Fax:713-861-4589
Practice Address - Street 1:1740 W 27TH ST STE 206
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1433
Practice Address - Country:US
Practice Address - Phone:713-861-6555
Practice Address - Fax:713-861-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE90702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113975001Medicaid
TX113975001Medicaid